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Health: Tuberculosis

Volume 713: debated on Monday 26 October 2009


Asked By

To ask Her Majesty’s Government what steps they are taking to raise awareness of tuberculosis in highly affected communities.

The Chief Medical Officer’s 2004 TB action plan makes raising awareness of TB one of its top priorities. The Government funded TB Alert to raise awareness among communities at particular risk and healthcare professionals, and also Find & Treat to work with vulnerable groups, such as the homeless, to increase uptake of TB screening.

My Lords, I thank the noble Baroness for that reply. Perhaps I should declare that I had TB in my teens. Have any evaluations been carried out to ascertain the effectiveness of the port-of-entry screening for TB?

I am not sure that having had TB is a declaration of interest, but the noble Baroness’s experience has helped us with our discussions. As she knows, screening new entrants for TB has been a long-standing government policy, as indeed has pre-entry screening in some of the countries. However, 80 per cent of people born outside the UK who develop infectious TB do so only after living in the UK for two years.

In my previous Answer, I referred to the fact that the HPA would be reviewing the effectiveness of port screening and there is a cross-governmental review of pre-entry screening to consider this in relation to TB management and how it affects the migrant population in general. The result of that will be led by the Department of Health and the Home Office. However, experts maintain that early detection and completion of treatment in tackling TB is a priority at local level and that is why our awareness-raising campaign is so important.

Is my noble friend satisfied that the campaign to raise awareness is working? How is it being monitored? What are the Government doing specifically about the drug-resistant forms of tuberculosis and do we have any powers to detain people who have drug-resistant TB?

The TB Alert awareness campaign was rolled out some two years ago. We can say that 90 primary care trusts are using awareness-raising material, such as leaflets in 20 different languages. In Bradford, for example, the TB Alert people are working with 170 GPs, issuing important messages. In Bristol, they are working with the homeless and substance abusers.

As regards drug-resistant TB, my noble friend raises an important point. About 1 per cent of TB cases are multiple-drug-resistant—that is about 50 to 60 cases a year—and a small proportion of them are classified as extremely drug-resistant. We have a system of identifying those, and under the Public Health Act 1984 we have powers, in certain circumstances, to order an individual to undergo medical examinations and to be detained in hospital. However, no one can force someone to undertake medical treatment. It is a very important question and it is one on which we are working very hard indeed.

My Lords, does the Minister agree that the Find & Treat project run in London is absolutely splendid? It has dedicated people who go around in mobile units to X-ray the homeless and the hard-to-find. How is funding for that project going? The DHSS funded it, but I think that now the PCTs must do so.

I know that the noble Baroness has an interest in this, having visited a prison where she saw the mobile units at work. This scheme will be evaluated in 2010. We are encouraging all London’s PCTs to put in the small amount of money required of each of them—in the region of £10,000 to £12,000—to ensure that both the mobile units that we currently have can be maintained and can continue with the very good work that they are doing. I believe that during the past year they have identified 300 to 400 cases.

Does the noble Baroness agree that it is in the interests of general public health that people who are at risk of developing TB are encouraged to go for early diagnosis and treatment? Can she confirm that it is not a requirement that a person has to be resident in the United Kingdom to receive diagnosis and treatment? If it is, can she tell the House whether that is a central message in the TB awareness campaign?

The key point of the TB awareness campaign is that anybody who might be infected with TB should be diagnosed as early as possible and should receive treatment. That would apply to anybody in the UK, both people who are resident and people who are visiting.

Can the noble Baroness tell the House whether the programme reaches the less hard to find, namely, those who are employed in the NHS, who, although they are tested on employment, may subsequently contract TB? It has been known for patients then to be infected by members of staff whose previous test was too long ago.

The noble Baroness raises a good point. All health service workers undergo screening. I cannot say whether that is continued at regular intervals, but I undertake to find out and let her know.

Can the noble Baroness advise what steps the Government will take to replace the invaluable services performed by the screening service at the junction of Greek Street and Soho Square at St Barnabas, which was forced to close for two years to make way for the excavation for Crossrail?

I am not aware of the detail of that, but it strikes me that the mobile screening units, of which we have two in London, will be essential under those circumstances.

Given the tremendous prevalence of TB from central and eastern Europe, particularly from Russia, where the pasteurisation of milk has long since ceased and where there is a great prevalence of TB in prisons, will the Minister put pressure on the Government to spend some funding bringing the DOTS programme back into Russia? I am sure that she will confirm that it is the full answer to the control of TB.

We have not at all abandoned the DOTS programme, which is about making sure that people take their medicine on time and in a supervised fashion.